A recent review article in Current Opinion in Ophthalmology discussed the off-label use of Botox (botulinum toxin type-A, Allergan) as an unconventional and relatively noninvasive solution for patients with lacrimal-gland mediated tear disorders. Besides its traditional use in treating strabismus and essential benign blepharospasm, Botox can be used for both epiphora and dry eye, the review says.

Botox injection in the lacrimal gland has led to high success rates in improving lacrimal outflow obstruction in elderly patients, in poor surgical candidates or in those unwilling to have surgery. The agent can also reduce tear drainage by injection into the medial lower eyelid near the punctum. Injections used for dry eye treatment cause reduction in lacrimal drainage function by paralyzing the orbicularis oculi muscle, decreasing blinking and the lacrimal pump.

The authors believe clinicians’ familiarity with the expanding ophthalmic options for Botox provides the chance to better serve patients, citing proper patient selection, dosing and site of application as important factors for successful therapy with the lowest risk of complication. They also note that intraglandular injection of Botox is an off-label use and informed consent is necessary.

Alsuhaibani HA, Eid AS. Botulinum toxin injection and tear production. Curr Opin Ophthalmol. July 10, 2018. [Epub ahead of print].